Chioma Uzoigwe1,2, Josh Noone3, Yuanjie Liang4, Sarah Naz Ali3, Cory Gamble5. 1. Real World Data Science and Innovation, Novo Nordisk Inc., Plainsboro, NJ, USA. coms@novonordisk.com. 2. Real World Evidence, Novo Nordisk Inc., 800 Scudders Mill Road, Plainsboro, NJ, 08536, USA. coms@novonordisk.com. 3. Health Economics and Outcomes Research, Novo Nordisk Inc., Plainsboro, NJ, USA. 4. Real World Data Science and Innovation, Novo Nordisk Inc., Plainsboro, NJ, USA. 5. Medical Affairs, Novo Nordisk Inc., Plainsboro, NJ, USA.
Abstract
INTRODUCTION: Liraglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), is effective in patients with type 2 diabetes (T2D), but treatment discontinuation without new T2D therapy initiation may compromise outcomes. METHODS: This retrospective cohort study (July 1, 2012, to December 31, 2019) identified patients ≥ 18 years with T2D in the Optum® Clinformatics® Data Mart who discontinued liraglutide (index date). Patients with continuous enrollment for ≥ 12 months before and after discontinuation (baseline), ≥ 6 months liraglutide coverage pre-index, and no new T2D therapy start during follow-up were included. Changes from baseline in all-cause healthcare resource utilization (HCRU; outpatient visits, emergency room [ER] visits, and hospitalization events), costs, and glycated hemoglobin (HbA1c) over 12 months after discontinuation were evaluated. RESULTS: Overall, 625 of 186,630 patients who discontinued liraglutide during the baseline period (mean [standard deviation (SD)] age, 62.1 [10.1] years) were included in the 12-month analysis. A significant increase in the rate of ER visits (rate ratio [95% confidence interval (CI)]: 1.23 per 100 person-months [1.05, 1.43]; P = 0.0079), hospitalizations (1.36 [1.09, 1.70]; P = 0.0056), and outpatient visits (1.03 [1.01, 1.06]; P = 0.0075) was observed. Total HCRU costs significantly increased after discontinuation ($436.12 per patient per month [$90.07, $782.17]; P = 0.0136), driven by significantly higher outpatient costs ($238.70 [$34.16, $443.25]; P = 0.0223). HbA1c increased significantly by 12 months from mean (SD) 7.37 (1.53) at baseline to 7.63 (1.64; difference: + 0.25 [95% CI 0.14, 0.36]; P < 0.0001). CONCLUSIONS: Patients who discontinued liraglutide showed increases in HCRU; costs, mainly driven by outpatient cost; and HbA1c within 12 months, emphasizing the importance of treatment optimization on clinical and economic outcomes in patients with T2D.
INTRODUCTION: Liraglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), is effective in patients with type 2 diabetes (T2D), but treatment discontinuation without new T2D therapy initiation may compromise outcomes. METHODS: This retrospective cohort study (July 1, 2012, to December 31, 2019) identified patients ≥ 18 years with T2D in the Optum® Clinformatics® Data Mart who discontinued liraglutide (index date). Patients with continuous enrollment for ≥ 12 months before and after discontinuation (baseline), ≥ 6 months liraglutide coverage pre-index, and no new T2D therapy start during follow-up were included. Changes from baseline in all-cause healthcare resource utilization (HCRU; outpatient visits, emergency room [ER] visits, and hospitalization events), costs, and glycated hemoglobin (HbA1c) over 12 months after discontinuation were evaluated. RESULTS: Overall, 625 of 186,630 patients who discontinued liraglutide during the baseline period (mean [standard deviation (SD)] age, 62.1 [10.1] years) were included in the 12-month analysis. A significant increase in the rate of ER visits (rate ratio [95% confidence interval (CI)]: 1.23 per 100 person-months [1.05, 1.43]; P = 0.0079), hospitalizations (1.36 [1.09, 1.70]; P = 0.0056), and outpatient visits (1.03 [1.01, 1.06]; P = 0.0075) was observed. Total HCRU costs significantly increased after discontinuation ($436.12 per patient per month [$90.07, $782.17]; P = 0.0136), driven by significantly higher outpatient costs ($238.70 [$34.16, $443.25]; P = 0.0223). HbA1c increased significantly by 12 months from mean (SD) 7.37 (1.53) at baseline to 7.63 (1.64; difference: + 0.25 [95% CI 0.14, 0.36]; P < 0.0001). CONCLUSIONS: Patients who discontinued liraglutide showed increases in HCRU; costs, mainly driven by outpatient cost; and HbA1c within 12 months, emphasizing the importance of treatment optimization on clinical and economic outcomes in patients with T2D.